(LML) A day on the ground

Leprosy Mailing List – November 7,  2016

Ref.: (LML) A day on the ground

From:  Joel Almeida, Mumbay and London

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Dear Pieter,

 

 

Thanks to Dr. Warren for her kind words (LML November 1, 2016). I note her concern about WHO advice.

 

The internet age has changed many things.  In the print era, peer review was by one or two referees. Delays were measured in months. Few people bothered to read the journals. 

 

Decisions were made by a handful of self-declared experts behind closed doors. These decisions were imposed on others, for better or worse. 

 

In the internet era, ideas can be put forth instantaneously. Hundreds of peers can examine a claim. They can respond instantaneously, online. Errors can be highlighted, and improvements suggested, immediately. No claims or views are exempt from quick discussion.

 

Nowadays it is much more difficult to persist in error. 

 

All this is good news for the populations of endemic countries. Even a simple email list like LML can serve as a platform for refining knowledge and views. 

 

So Dr. Warren should not be too worried about WHO's limitations. There is a relatively new team at WHO's GLP, and everyone expects the best of them. In any case, whatever is sound will be widely used. Whatever is suspect or counter-productive will be ignored. All of us can suggest improvements.

 

Now every claim or proposal (or fad) can be measured by simple yardsticks, such as: 

 

1. Does this tend to destroy or rebuild effective specialist skills and services?  

2. Does this increase or decrease the protection of nerves in the population at risk? 

3. Does this hasten or delay the detection or protection of people with lepromatous leprosy?

4. Does this improve or worsen the quality of life for people disfigured by leprosy?

 

Leprosy in India has been increasing for at least a decade, as suggested by the doubling in incidence rate of newly detected cases with visible deformities at diagnosis. We need to rebuild expertise, not dilute it. 

 

There is a limit to what inexpert village workers can do. Detecting and treating silent neuritis, or even diagnosing lepromatous leprosy, takes skill. Trained and skilled leprosy workers, equipped with transportation and covering a large population, would transform the prospects for nerve protection and skilled early detection. India had such skilled and mobile workers, until people started boasting about a fictitious victory. This complacency was a gift to M. leprae and a blow to the people of India.

 

Thanks to the internet and LML, we now keep improving our knowledge and practice at a good pace. We are in a new era of leprosy control, and a new era of online scientific discussion. The ivory tower is not taken so seriously now. Clues from the ground are no longer easy to brush aside. The Indian government is rebuilding leprosy services. All of us can contribute to continuous improvement. The prospects for the population at risk are steadily improving. 

 

The more skilled workers we train and fund, the more nerves and people we will protect. Those Indian citizens who took the government to court recognized this and sought adequate staffing of leprosy services. This is the low-hanging fruit, easier to reach than some of our bigger but more distant ambitions. 

 

Regards,

 

Joel Almeida

in Asia 1975-1990

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LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com

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